Without doubt, breast cancer is a game-changer, altering every area of life and relationships. At first, amid the flurry of medical decisions, surgery, chemo, and recovery, you don’t have the time or energy to think about sex. But then… how do you make your way when all the furniture is rearranged? When your body, your emotions, your self-image and feeling of security, and your relationship with your partner are so permanently changed?

For a while, sex is understandably the last thing on your mind. Your chest is a surgical site; chemotherapy and radiation may make you nauseous, bloated, and incredibly fatigued; it may induce menopause if you haven’t already made that passage. Cancer survivors frequently experience depression as well. It’s important to know that if you don’t feel like sex for a period of time, you don’t have to go there. Focus on getting well first, say the experts, without completely shutting the door to intimacy. You can still love and support each other in small ways—holding hands, taking a walk, reading in bed together—to keep the coals alive during this period of stress and anxiety.

Your partner is under a lot of pressure, too, and is probably struggling to find purchase on the slippery slope of this crisis, uncertain about how to support you, and how or when to approach the sticky wicket of sex. Your partner may be waiting for you to make the first move, or be afraid of hurting you.

It might be helpful for both of you (or just your partner) to talk with your doctor or a counselor. Forthright, open communication about sex (or any other issue) can make the difference between feeling your way in the dark alone or shining a light on a difficult path. The most challenging situations can be overcome with honest dialog and the willingness to seek help and information.

Over time, as you begin to heal, you face the inevitable hurdle: resuming your sexual life. How will your partner respond to the way you look; for that matter, how do you feel about your changed body? Your incision site may still be tender or you may be undergoing reconstructive surgery. Chemotherapy may have brought on menopausal symptoms. Maybe you’re not sure you feel like having sex at all, and you certainly don’t feel very sexy.

First, take it slow. You (and your partner) have been through a prolonged, life-threatening crisis. In addition, you’ve lost an important erogenous zone. Unless your doctors have been able to spare your nipples and their nerve endings, you probably can’t feel anything in an area that used to be erotic and arousing.

You and your partner need to become acquainted with your new body. You may have lost your breast(s), but other parts—neck, shoulders, ears—may become more sensitive. Your first foray into sex could be an exercise in gradually raising your awareness of sensation rather than worrying about intercourse.

Try simply touching each other. Leave the genitals out for now. Talk about what feels good. Or—don’t talk at all, just be together, touching each other. Slowly, in this session or the next, add genital exploration and move on to intercourse when it feels comfortable. Sex will be different—and not necessarily for the worse.

Experts say that you don’t have to “love your scars.” If you’re uncomfortable letting your partner see you naked, wear sexy lingerie. On the other hand, your partner may be able to reassure you that you are as loved as you ever were, and that’s incredibly affirming.

Second, assemble your tool kit. This should include lubricants to make penetration easier and sex more pleasurable. Maybe experiment with toys; try massage oils. Experiment with positions that are comfortable. Lying on the affected side may be painful, for example. You may prefer being on top or on your knees with your partner behind you. Since so much is different anyway, why not shake up the routine? Be sure to discuss any problems or questions about sex with your doctor. A solution may be easier than you think.

In a blog about sex after having had both breasts prophylactically removed, one young woman likens the experience of resuming sex with her husband to a second adolescence—shy, awkward, fumbling, uncertain. “But like adolescence, this is a phase I will grow out of. I will become more comfortable with my body and my husband will too.… But all of this is uncharted territory, and I'm trying to do what feels right to me. Each of us will recover our sexuality at her own pace, and this is the (frank) truth about mine.”